Race Dialogue Series: Part 3
This is the third post in a four-part series about the Race Dialogue Series created by Class of 2024 medical students in Spring 2020 and continued this summer.
The post below is Class of 2024 medical student, Mahima Poreddy’s, reflection on the third session of the series – a presentation by University of Vermont Larner College of Medicine Professor of Medicine and UVM Medical Center Director of Medical Ethics, Tim Lahey, M.D.
“How were you “recruited,” or not, into medicine?” asked Dr. Tim Lahey.
The responses were varied and showed a diverse range of experiences and backgrounds among my fellow medical student attendees.
Some students responded with personal stories of familial expectations to become successful as doctors or engineers, while others spoke about the benefits of having access to career paths in medicine and in other well-regarded professions, and others spoke about the drawbacks of an education that simply does not present medicine as an option, particularly for those who have been traditionally underrepresented in medicine (URiM).
Historically and currently, URiM people disproportionately lack the resources needed to meet the prerequisites for medical school and even consider it a possibility. The prospect of medical school is also more discouraging for URiM students when you factor in nation-wide exorbitant tuition and living costs, low resident physician pay, and long work hours.
In the face of these overwhelming challenges, how do we move towards a healthcare workforce that is more representative of the country’s demographics and an education system that supports the advancement of URiM providers?
Recently, the NYU School of Medicine announced tuition-free medical education. In my opinion, this is something that, in a perfect world, all medical schools would do. However, the financial and other barriers to do so are steep for institutions of higher education in a society which has created education as a for-profit industry. In lieu of tuition-free medical school, effective steps can still be taken.
The creation of pipeline programs can be a good first step, such as the one UVM offers through the Master of Medical Science (MMS) program. Through the program, two students who come from backgrounds typically underrepresented in medicine (URiM) are offered the opportunity to complete the MMS program at no cost and become accepted at the Larner College of Medicine upon successful completion. Additional nation-wide steps include finding creative ways to eliminate the built-in costs of applying to medical school, such as application fees, the MCAT, and travel and lodging costs for in-person interviews.
Additionally, Dr. Lahey encouraged participants to consider how we might “break the mold” – rethinking systems in our medical schools while maintaining high standards for medical training. Could we envision a future where medical curricula are created in such a way that allow students to work part-time during medical school, even if it means taking longer to finish the degree? How can the system change to ensure trainees have adequate time for family, mental health, bereavement, and other important aspects of life that cannot be pushed aside for work? These options may seem impossible in a culture that prioritizes work at all costs, said Lahey, but they are essential for supporting future physicians who are compassionate and socially responsible.
As the conversation progressed, we discussed additional aspects of medical training that present barriers for URiM students including being mentored inadequately and feeling excluded. Mentors, especially in cross-racial mentorship situations, need to be aware of the specific struggles that URiM trainees regularly face in medicine. Successful mentorship can allow URiM mentees to feel heard and identify opportunities for career advancement. On the other hand, mentors, in addition to faculty and peers, can be the source of microaggressions and racist actions that exclude and harm URiM students. The recipient of such an action or comment often seriously considers the consequences of reporting the incident due to fear of job loss or reputational harm.
Luckily, a strategy to improve this process is a peer-to-peer conversation model – a model that will be implemented through the Office of Diversity, Equity and Inclusion at UVM Larner Med. This approach “calls in” the source of the inappropriate action or comment to recognize how their actions or words hurt someone else and how to move forward.
Lastly, our session touched on the importance of adapting our curriculum to teach race-conscious medicine over race-based medicine. In addition to patients, BIPOC students and faculty are supported when everyone is cognizant of the social, political, and historical complexities that cause certain conditions or diseases to be more prevalent in a certain racial or ethnic group. Medical education should promote reviewing literature on whether differences in incidence for specific conditions are due to biology, social factors, or a mix of the two. In addition, using the appropriate race and ethnicity terminology, for example African rather than African American when contextually accurate, is vital.
Conversations regarding this subject and many others on the topic of racism and social justice are essential for medical providers. By connecting with each other in spaces that promote learning and making mistakes, we can question the structures we have come to accept.
It is not enough to recruit URiM students and faculty; medical education must foster an environment that allows underrepresented people to thrive, from primary education to the peak of their career.